Kentucky Rustic Furniture

Mail in Order Form

Order Form

For more information email: danmoffett54@gmail.com
 
TO ORDER:
Please print this page using the "print" function on your browser, fill it out, and send it along with check or money order to: 

Dan Moffett
 6218 White Oak Rd, Junction City, KY 40440
(859) 209-0343

When you are finished printing, use the "back" function of your browser to return to the last page viewed.



NAME:__________________________________________________

SHIP TO ADDRESS:____________________________________________________                     (no PO box)
Indicate:  Business (__________)   or Residential (__________)

CITY:____________________________________________________

STATE:___     ZIP:___________ COUNTRY:___________ PHONE:_______________ 

EMAIL ADDRESS________________________________________________________


Prices are in US Funds.
Sales outside the U. S. please send an international money order.

Please send me:

QTY
ITEM
UNITS
DESCRIPTION
UNIT PRICE
SHIPPING
TOTAL
_______ _______ _________
______________________
______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________
_______ _______ _________ ______________________ ______________ _________ __________




SUBTOTAL
_________ __________




KY RESIDENTS AD 6% SALES TAX

 
 

_________


 
 

__________





TOTAL
_________ __________

CALL FOR SHIPPING QUOTE ON LARGE PIECES.
LARGE PIECES SHIPPED FREIGHT COLLECT

Please check your method of payment:

_______Check  _______Money Order   ______Bank Check  _______ International Money Order